Association between health literacy and depressive emotion among occupational groups in Shanghai

Background At present, insufficient support for enterprise health environment and career development may lead to severe depressive emotion among occupational groups.

Objective To investigate current state of depressive emotion and the relationship between health literacy and depressive emotion among occupational groups in Shanghai, and to provide evidence for formulating health management measures to alleviate depressive emotion among the occupational population.

Methods This cross-sectional survey, using two-stage stratified sampling, was from December 2022 to February 2023, and selected 2548 active workers from 151 enterprises in Shanghai. A total of 2489 valid questionnaires were returned, with a recovery rate of 97.68%. Health literacy, internality health locus of control, and depressive emotion were evaluated by the Health Literacy Questionnaire, the Multidimensional Health Locus of Control Scale-Internality Health Locus of Control, and the Patient Health Questionnaire Depression Scale-9 item (PHQ-9), respectively. R 4.2.2 software was used for statistical analysis, binary logistic regression model was used to analyze the association between health literacy, internality health locus of control, and the risk of depressive emotion, and multiple linear model was used to analyze the correlation between health literacy, internality health locus of control, and PHQ-9 related indicators (total score, affective score, and somatic score).

Results A total of 2489 workers aged 18 years and above in Shanghai were included in the analysis, 868 of them reported depressive emotion, and the positive rate of depressive emotion was 34.9%. The total score, affective score, and somatic score of PHQ-9 in M(P₂₅, P₇₅) were 3.00 (0.00, 6.00), 1.00 (0.00, 4.00), and 1.00 (0.00, 3.00), respectively. The results of binary multiple logistic regression analysis showed that after adjusting for selected confounders, no health literacy (OR=1.32, 95%CI: 1.10, 1.60; P=0.004) and low level of internality health locus of control (OR=1.66, 95%CI: 1.35, 2.05; P < 0.001) were associated with an increased risk of reporting depressive emotion. The results of multiple linear model showed that the lack of health literacy and low internality health locus of control were positively correlated with the total score, affective score, and somatic score of PHQ-9.

Conclusion Depressive emotion among the working population in Shanghai is prominent, and more than 1/3 of them report depressive emotion. Lower health literacy and internality health locus of control are related to an increased risk of depressive emotion in the study population. Improving occupational health literacy and enhancing internality health locus of control are expected to prevent depressive emotion in occupational groups.